Endovascular replacement of aortic valve, aortic root, and ascending aorta

Abstract

The present disclosure relates generally to methods and apparatus for endovascular replacement of the aortic valve, aortic root, and ascending aorta. The present subject matter includes various embodiments of methods and apparatus for connecting the coronary arteries to an endovascular assembly including an aortic valve device (AVD), an aortic root graft, and an ascending aortic stent graft. The present subject matter provides for replacement of the aortic valve, aortic root, and ascending aorta without requiring open-heart surgery. It provides different options for connections to the coronary arteries and for assembling the aortic valve device and the aortic root graft.

What is claimed is: 
     
         1 . An apparatus for endovascular replacement of an aortic valve, an aortic root, and an ascending aorta of an organism having a heart and coronary arteries, comprising:
 an assembly including an ascending stent graft, an aortic root graft connected to the ascending stent graft, and an aortic valve device (AVD) connected to the aortic root graft, the ascending stent graft, aortic root graft, and AVD forming a unitary device configured for endovascular delivery over a wire and to be in a collapsed state allowing for the endovascular delivery, the ascending stent graft and the aortic root graft configured to be delivered to the ascending aorta, the AVD configured to be delivered to the aortic root, proximal the ascending stent graft, the aortic root graft configured to be connected to the coronary arteries.   
     
     
         2 . The apparatus of  claim 1 , wherein the AVD is connected to the aortic root graft using a plurality of hooks, a proximal snare and surgical knot, or surgical suturing. 
     
     
         3 . The apparatus of  claim 1 , wherein the AVD includes a proximal portion having protrusions, the aortic root graft includes a base having fenestrations, and the AVD is connected to the aortic root graft by inserting the protrusions into the fenestrations. 
     
     
         4 . The apparatus of  claim 1 , wherein the AVD is connected to the aortic root graft using one or more of sliding or binding surfaces or using one or more of magnetic technology, chemical technology, or nanotechnology. 
     
     
         5 . The apparatus of  claim 1 , wherein the aortic root graft includes an exterior portion configured to be apposed to aortic valve annulus of the organism, the exterior portion made of one or more materials selected to reduce paravalvular leaks. 
     
     
         6 . The apparatus of  claim 1 , wherein the AVD includes a radially stretchable polyester or pTFE for expansion of the AVD to aortic valve annulus of the organism during a cardiac cycle. 
     
     
         7 . The apparatus of  claim 1 , wherein the assembly is sized to prevent narrowing or hourglass shaping of a lumen of the aortic root or the ascending aorta. 
     
     
         8 . The apparatus of  claim 1 , wherein the aortic root graft includes one or more coronary fenestrations configured for connection to the coronary arteries. 
     
     
         9 . The apparatus of  claim 1 , wherein the aortic root graft includes one or more stent grafted fenestrations configured for connection to the coronary arteries. 
     
     
         10 . The apparatus of  claim 1 , wherein the aortic root graft includes one or more stent graft branches configured for connection to the coronary arteries. 
     
     
         11 . The apparatus of  claim 10 , wherein the aortic root graft is configured to be connected to the coronary arteries through one or more conduits connected to the one or more stent graft branches. 
     
     
         12 . The apparatus of  claim 1 , wherein the aortic root graft includes one or more coronary fenestrations, stent grafted fenestrations, or stent graft branches configured for connection to the coronary arteries and positioned on the assembly according to coronary anatomy constellation of the organism. 
     
     
         13 . The apparatus of  claim 1 , including passageways for connection to the coronary arteries by one or more internal, partly internal, or external conduits connected to right and left stent graft branches configured to be connected to the right and left coronary arteries, respectively, wherein the length of each conduit may vary from starting at a distal portion of the ascending aortic graft to just above the aortic root graft and wherein an internal orifice of each conduit may have an oversized oval or round orifice to facilitate distant coronary wire cannulation. 
     
     
         14 . A method for endovascular replacement of an aortic valve, aortic root, and ascending aorta of an organism having a heart and coronary arteries, comprising:
 delivering an assembly over a wire, the assembly being a unitary device including an ascending stent graft, an aortic root graft connected to the ascending stent graft, and an aortic valve device (AVD) connected to the aortic root graft and in a collapsed state during the delivery, the delivery including positioning the ascending stent graft and the aortic root graft in the ascending aorta and positioning the AVD in the aortic root, proximal the ascending stent graft; and   connecting the coronary arteries to the aortic root graft.   
     
     
         15 . The method of  claim 14 , wherein delivering the assembly comprises delivering the assembly with the AVD connected to the aortic root graft using a plurality of hooks, a proximal snare and surgical knot, or surgical suturing. 
     
     
         16 . The method of  claim 14 , wherein the AVD includes a proximal portion having protrusions, the aortic root graft includes a base having fenestrations, and delivering the assembly comprises delivering the assembly with the AVD connected to the aortic root graft by inserting the protrusions into the fenestrations. 
     
     
         17 . The method of  claim 14 , wherein delivering the assembly comprises delivering the assembly with the AVD connected to the aortic root graft using one or more of sliding or binding surfaces or using one or more of magnetic technology, chemical technology, or nanotechnology. 
     
     
         18 . The method of  claim 14 , wherein delivering the assembly comprises delivering the assembly sized to prevent narrowing or hourglass shaping of a lumen of the aortic root or the ascending aorta. 
     
     
         19 . The method of  claim 14 , wherein connecting the coronary arteries to the aortic root graft comprises connecting the coronary arteries to the aortic root graft using one or more coronary fenestrations of the aortic root graft. 
     
     
         20 . The method of  claim 14 , wherein connecting the coronary arteries to the aortic root graft comprises connecting the coronary arteries to the aortic root graft using one or more stent grafted fenestrations of the aortic root graft. 
     
     
         21 . The method of  claim 14 , wherein connecting the coronary arteries to the aortic root graft comprises connecting the coronary arteries to the aortic root graft using one or more stent graft branches of the aortic root graft. 
     
     
         22 . The method of  claim 14 , wherein the aortic root graft includes one or more coronary fenestrations, stent grafted fenestrations, or stent graft branches configured for connection to the coronary arteries, and further comprising adjusting one or more locations of the one or more coronary fenestrations, stent grafted fenestrations, or stent graft branches on the assembly according to coronary anatomy constellation of the organism. 
     
     
         23 . The method of  claim 14 , wherein delivering the assembly comprises placing the assembly in a delivery system and introducing the assembly transfemorally or through an axillary artery of the organism, a subclavian artery of the organism, a carotid artery of the organism, or an apex of the heart using the delivery system.